Medicare Payment Integrity Analyst - Remote

WHAT WE CAN OFFER YOU:

• Estimated Salary (Levels have variable responsibilities and qualifications):
  • Medicare Payment Integrity Analyst: $25.00 - $31.50 per hour, plus annual bonus opportunity.
  • Lead Medicare Payment Integrity Analyst:  $58,656 - $75,078, plus annual bonus opportunity.
• 401(k) plan with a 2% company contribution and 6% company match.
• Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
• Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.

WHAT YOU'LL DO:

• Performs review of healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA).  
• Act as a liaison with 3rd party vendors, including identifying data trends, validating rules, making recommendations for improvement, and providing updates to management.  
• Proactively seeks out and develops leads from a variety of sources (e.g., CMS, OIG, HFPP, NHCAA)  
• Perform evaluation of leads, complaints, and/or investigations.  Conduct independent reviews resulting from the discovery of situations that potentially involve FWA, including communicating with medical providers and policyholders.   
• Develop appropriate recommendations and suggestions based on analysis and collaborate with management in the development of action plans where required. 
• Contact medical providers and policyholders to substantiate claims.
• Adjudicate claims based on FWA review findings.

WHAT YOU’LL BRING:

• Prior experience performing comprehensive reviews of Medicare healthcare claims to ensure accuracy, compliance with federal and state regulations, and alignment with contractual requirements.  
• Experience working with National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
• In-depth knowledge of Medicare billing rules, and familiarity with CMS guidelines.
• Experience identifying and developing leads from trusted sources like CMS, OIG, HFPP, and NHCAA, evaluating them to uncover potential FWA cases.  
• Knowledge of medical coding, billing practices, and healthcare regulations, as well as understanding of ICD, CPT, HCPCS, DRG, revenue codes, and other billing guidelines.
• You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
• Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

PREFERRED:

• Certified Professional Coder certification or equivalent.  

We value diverse experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply! 

If you have questions about your application or the hiring process, email our Talent Acquisition area at careers@mutualofomaha.com. Please allow at least one week from time of applying if you are checking on the status.

Stay Safe from Job Scams
Mutual of Omaha only accepts applications from mutualofomaha.com/careers. Legitimate communications will come from '@mutualofomaha.com.' We never request sensitive information or extend job offers without conducting interviews. For more details, check our Hiring FAQs. Stay alert for scams and apply securely!

Fair Chance Notices